Challenges in Recruiting and Training Drug Treatment Patients as Peer Outreach Workers: A Perspective From the Field

Abstract

Hispanic patients were recruited from methadone maintenance treatment programs in 2005–2008 to be trained as peer outreach workers, targeting migrant drug users from Puerto Rico. Goals of the outreach focused on reducing HIV-related risk behaviors. A total of 80 peers were recruited from 4 clinics in New York and New Jersey. Following training, they conducted outreach in their communities for 12 weeks. This paper describes the challenges encountered during the recruitment, training, and outreach phases of the project, from the field perspective. Recommendations for future efforts in training drug treatment patients as outreach workers are provided.

RÉSUMÉ

Difficultés à recruter et à former les patients de traitement de drogue en tant que travailleurs éducatifs: La perspective opérationelle

Des patients hispaniques ont été recrutés dans des programmes de traitement d’entretien de méthadone en 2005–2008 pour les former en tant que travailleurs éducatifs, visant les consommateurs de drogue émigrants du Porto Rico. Les buts du projet étaient concentrés sur la réduction des comportements qui augmentent le risque de contracter ou transmettre le SIDA. Un total de 80 personnes a été recruté dans 4 cliniques and les états de New York et du New Jersey. Après la formation, ils ont conduit les efforts éducatifs dans leurs communautés pendant 12 semaines. Cet article décrit les difficultés pendant le recrutement, la formation, et les phases éducatives du projet, de la perspective de champ (opérations). Des recommandations pour de futurs efforts à former des patients de traitement de drogue comme travailleurs éducatifs sont fournies.

RESUMEN

Retos en reclutar y entrenar pacientes de programas de tratamiento de drogas como trabajadores pares de alcance: Una perspectiva del campo

Pacientes Hispanos fueron reclutados de programas de tratamiento de metadona entre los años 2005–2008 para ser entrenados como trabajadores pares de alcance, enfocando en migrantes de Puerto Rico usarios de drogas. Las metas del trabajo de alcance se enfocaron en reducir comportamientos de riesgo de VIH/SIDA. Un total de 80 Pares fueron reclutados de 4 clinícas en Nueva York y Nueva Jersey. Luego de ser entrenados, los Pares condujeron trabajo de alcance en su comunidad por 12 semanas. Este estudio describe los retos enfrentrados durante las fases de reclutamiento, entrenamiento y de trabajo de alcance utilizando una perspectiva del campo. Ofrecemos recomendaciones para esfuerzos futuros de estrenar pacientes de programas de tratamiento de drogas como trabajadores de alcance.

Keywords :

• peer outreach workers
• HIV prevention
• drug treatment patients
• cultural mediators

THE AUTHOR

Rosa M. Colón is Field Site Coordinator at NDRI, for research projects documenting the experiences of migrant substance users to the United States and is currently examining the health and sexual histories of substance users in New York City. Ms. Colón has extensive experience with field projects related to HIV/AIDS and substance use, and for more than 23 years has supported and advocated for the health and well-being of substance users in Puerto Rico and the United States. She worked at the Lower East Side Harm Reduction Center and is currently on their Board of Directors. Ms. Colón has been a tireless AIDS and drug user advocate and has been invited to attend national and state conferences to speak on the issue. Most recently, she has given voice in New York to the plight of substance users living with AIDS in Puerto Rico and is co-founder of Unidos Dandolé Cara al SIDA, New York City Chapter. Through this mechanism, she continues to work closely with service providers and advocates in the Island to continue the fight against HIV/AIDS and to open the dialogue on Harm Reduction practices and philosophy.

Sherry Deren, Ph.D., is the Director of the Center for Drug Use and HIV Research (CDUHR) at New York University College of Nursing in NYC. Dr. Deren has been Principal Investigator for many NIDA-funded research projects related to drug use and HIV. She was the Principal Investigator for the study described in this paper. In addition, as Director of CDUHR, a NIDA-funded P30 Research Center focused on the socio-behavioral study of drug use-HIV/AIDS, she oversees a research infrastructure for over 25 research projects at the NYU College of Nursing and affiliated institutions. She is also the co-founder of the New York HIV Research Centers Consortium, composed of over 20 HIV research centers in the New York tri-State area. She has served on NIH research review committees, is vice-chair of the Scientific Advisory Committee for amfAR, and is the author of many articles on HIV/AIDS prevention among high-risk substance users.

Honoria Guarino, Ph.D., specializes in qualitative research regarding the social aspects of substance abuse and HIV/AIDS. Dr. Guarino received her Ph.D. in Anthropology from the University of Arizona; her dissertation research examined the relationship between HIV positive individuals’ self-concepts and their differing levels of involvement in activities sponsored by AIDS service organizations. Since 2000, she has worked for National Development and Research Institutes on various behavioral research projects relating to issues of substance abuse and HIV/AIDS in New York City. Currently, she is Project Director for a study to evaluate the effectiveness of a computerized patient education program for opioid-dependent individuals in methadone maintenance treatment.

Milton Mino was Project Director of the study described in this paper. He has managed several large drug-use- and health-related research intervention studies, including those on adolescents and criminal justice populations, using both quantitative and qualitative methodologies. He has authored reports aimed at scientific audiences as well as policy makers and drug treatment providers.

Sung-Yeon Kang, Ph.D., was the data coordinator of this project at the National Development and Research Institutes, Inc., New York City. During the last 20 years, Dr. Kang has been involved in a wide variety of projects funded by the National Institute on Drug Abuse and other agencies. These projects have focused on drug abuse and related problems, such as HIV/AIDS, psychological status, criminal involvement, and other public health issues. Her numerous published articles include topics on HIV/AIDS risk behaviors and networks among Puerto Rican drug users, HIV risks among incarcerated populations, evaluation of drug user treatment, and the validity of self-reported drug use. Her current research interest is to identify factors that are associated with gender differences in healthcare and drug treatment utilization.

Notes

1 Treatment can be briefly and usefully defined as a planned, goal-directed, temporally structured change process, of necessary quality, appropriateness, and conditions (endogenous and exogenous), which is bounded (culture, place, time, etc.) and can be categorized into professional-based, tradition-based, mutual-help based (AA, NA, etc.), and self-help (“natural recovery”) models. There are no unique models or techniques used with substance users—of whatever types and heterogeneities—which aren't also used with non-substance users. In the West, with the relatively new ideology of “harm reduction” and the even newer Quality of Life (QOL) treatment-driven model there are now a new set of goals in addition to those derived from/associated with the older tradition of abstinence-driven models. Editor's note.